Sources of information and behavioral patterns in online health forums: observational study

The quality of informational social support in online health communities: A content analysis of cancer-related discussions

Objective

Informational social support is one of the main reasons for patients to visit online health communities (OHCs). Calls have been made to investigate the objective quality of such support in the light of a worrying number of inaccurate online health-related information. The main aim of this study is to conceptualize the Quality of Informational Social Support (QISS) and develop and test a measure of QISS for content analysis. A further aim is to investigate the level of QISS in cancer-related messages in the largest OHC in Slovenia and examine the differences among various types of discussion forums, namely, online consultation forums, online support group forums, and socializing forums.

Methods

A multidimensional measurement instrument was developed, which included 20 items in a coding scheme for a content analysis of cancer-related messages. On a set of almost three million posts published between 2015 and 2019, a machine-learning algorithm was used to detect cancer-related discussions in the OHC. We then identified the messages providing informational social support, and through quantitative content analysis, three experts coded a random sample of 403 cancer-related messages for the QISS.

Results

The results demonstrate a good level of interrater reliability and agreement for a QISS scale with six dimensions, each demonstrating good internal consistency. The results reveal large differences among the social support, socializing, and consultation forums, with the latter recording significantly higher quality in terms of accuracy (M = 4.48, P < .001), trustworthiness (M = 4.65, P < .001), relevance (M = 3.59, P < .001), and justification (M = 3.81, P = .05) in messages providing informational social support regarding cancer-related issues.

Conclusions

This study provides the research field with a valid tool to further investigate the factors and consequences of varying quality of information exchanged in supportive communication. From a practical perspective, OHCs should dedicate more resources and develop mechanisms for the professional moderation of health-related topics in socializing forums and thereby suppress the publication and dissemination of low-quality information among OHC users and visitors.

Changes in Alcohol Consumption among Users of an Internet Drug Forum during a COVID-19 Lockdown

BACKGROUND

The aim of the present study was to assess the frequency and clinical correlates of users of an Internet drug forum who changed their alcohol use during the March-May 2020 COVID-19 lockdown in France.

METHODS

An anonymous Internet-based cross-sectional survey during the COVID-19 lockdown was used via messages on a French Internet drug forum. Participants reported any increase in their alcohol consumption during the lockdown. Alcohol craving and depressive/anxiety symptoms were assessed using the Obsessive and Compulsive Drinking scale (OCDS) and Hospital Anxiety and Depression scale (HADS).

RESULTS

Of 1310 respondents, 974 (79% of 1270) participants reported alcohol use before lockdown. During the lockdown, 405 participants (41.6%; IC95 (38.5-44.7)) reported an increase. Odds of an increase in alcohol consumption was higher for those with HADS scores higher than 7 (aOR: 2.19; p = 0.00002), OCDS scores greater than 7 (aOR: 3.50; p < 0.001), and daily psychostimulant use (aOR: 1.85; p = 0.002).

CONCLUSIONS

Users of an Internet drug forum who reported high levels of depressive symptoms, high levels of alcohol craving, and the use of psychostimulants were more likely to increase alcohol consumption during a COVID-19 lockdown.

Better safe than sorry: a study on older adults' credibility judgments and spreading of health misinformation

The online world is flooded with misinformation that puts older adults at risk, especially the misinformation about health and wellness. To understand older adults' vulnerability to online misinformation, this study examines how eye-catching headlines and emotional images impact their credibility judgments and spreading of health misinformation. Fifty-nine older adults aged between 58 and 83 years participated in this experiment. Firstly, participants intuitively chose an article for further reading among a bunch of headlines. Then they viewed the emotional images. Finally, they judged the credibility of health articles and decided whether to share these articles. On average, participants only successfully judged 41.38% of health articles. Attractive headlines not only attracted participants' clicks at first glance but also increased their credibility judgments on the content of health misinformation. Although participants were more willing to share an article they believed than not, 62.5% of the articles they want to share were falsehoods. Older adults in this study were notified of possible falsehoods in advance and were given enough time to discern misinformation before sharing. However, these efforts neither lead to a high judgment accuracy nor a high quality of information that they wanted to share. That may be on account of eye-catching headlines which misled participants into believing health misinformation. Besides, the most older adults in this study may follow the "better safe than sorry" principle when confronted with health misinformation, that is to say they would rather trust the misinformation to avoid health risks than doubt it.

Understanding the use of heart failure online health forums: a qualitative study

AIMS

Heart failure is a major public health challenge and is described as an epidemic. Many people resort to the internet as a source of health information and online health forums have become an increasingly common way to obtain information and support regarding health-related issues. This study aims to explore what information people concerned about heart failure seek from online health forums, and how this shapes decision-making, trust, and interactions with healthcare professionals.

METHODS AND RESULTS

Widely available internet search engines (Google, Yahoo, and Bing) were used to identify online health forums, accessed by people seeking information on heart failure. Comments posted between 2016 and 2019 were screened, downloaded, and analysed thematically. Normalization Process Theory provided the underlying conceptual lens to inform analysis. Ten online health forums were identified, and 204 individual posts analysed. Three themes were identified [(information and support needs; online diagnosis; and relationship with healthcare professionals (HCPs)]. The most common purpose for using online health forums was to plug information/knowledge gaps surrounding diagnosis or treatments (e.g. discussion of results, medication/health insurance queries). They were used as a tool to aid decision-making regarding, (i) whether to seek further medical attention and (ii) lifestyle choices, medications, and other advice surrounding concerns. Negative experiences with HCPs were discussed, and sometimes online health forums appeared to promote distrust with HCPs.

CONCLUSION

Online health forums offer a supportive platform and help fill key informational gaps. However, online forums may amplify distrust with HCPs.

An analysis of the diagnostic accuracy and peer-to-peer health information provided on online health forums for heart failure

AIMS

To examine the accuracy of diagnostic responses and types of information provided on online health forums.

DESIGN

Qualitative descriptive study.

METHODS

This paper reports the findings of a thematic analysis of peer responses to posts included on heart failure online health forums, to understand the quality and types of information provided. Responses posted between March 2016 and March 2019 were screened, collected and analysed thematically using Braun & Clarke. Themes were conceptually underpinned by Normalization Process Theory. Responses were assessed for quality against the NICE and SIGN guidelines to determine whether they were evidence based or not.

RESULTS

The total number of responses collected for analysis was 639. Five main themes were identified: diagnostic, experiential, informational, peer relations and relationships with healthcare professionals. Out of 298 diagnostic responses, 5% were guideline evidence-based and 6% had information that were partly evidence-based. Non-evidence based and potentially dangerous responses were 10%. Experiential responses were 10%; 23% included advice that was not supported with any clinical evidence; and 46% signposted users to other online references/healthcare professionals.

CONCLUSION

Online health communication largely focuses on provision of experiential responses to assist those in need of pre- or post-diagnosis advice and support. However, there is evidence of inaccurate information provision which suggests the use of a moderator would be beneficial.

IMPACT

This study suggests heart failure online health forums are a source of support, however, there are potential risks. Increasing nurses and other health care professional's awareness of online health forums will be important. Additional training is needed to help them learn more about patient's use of online health forums, to gain a better understanding about the types of information sought, and how best to address such knowledge deficits. Healthcare systems must ensure sufficient time and resources are available to meet information needs for people with heart failure.

Examining Patterns of Information Exchange and Social Support in a Web-Based Health Community: Exponential Random Graph Models

Background

Although an increasing number of studies have attempted to understand how people interact with others in web-based health communities, studies focusing on understanding individuals’ patterns of information exchange and social support in web-based health communities are still limited. In this paper, we discuss how patients’ social interactions develop into social networks based on a network exchange framework and empirically validate the framework in web-based health care community contexts.

Objective

This study aims to explore various patterns of information exchange and social support in web-based health care communities and identify factors that affect such patterns.

Methods

Using social network analysis and text mining techniques, we empirically validated a network exchange framework on a 10-year data set collected from a popular web-based health community. A reply network was extracted from the data set, and exponential random graph models were used to discover patterns of information exchange and social support from the network.

Results

Results showed that reciprocated information exchange was common in web-based health communities. The homophily effect existed in general conversations but was weakened when exchanging knowledge. New members in web-based health communities tended to receive more support. Furthermore, polarized sentiment increases the chances of receiving replies, and optimistic users play an important role in providing social support to the entire community.

Conclusions

This study complements the literature on network exchange theories and contributes to a better understanding of social exchange patterns in the web-based health care context. Practically, this study can help web-based patients obtain information and social support more effectively.

Effectiveness of avatar-based technology in patient education for improving chronic disease knowledge and self-care behavior: a systematic review

OBJECTIVE

The objective of the review was to examine the effectiveness of patient education using avatar-based technology on knowledge and self-care behaviors in patients with chronic disease.

INTRODUCTION

Chronic disease is a major global problem. Patients with chronic disease who engage in self-care and self-management of their illnesses have better health outcomes and fewer hospitalizations and complications. Currently, information and communication technologies are used to support self-care and improve health outcomes. Within the body of literature, research into avatar-based technology for patient education is growing rapidly. To date, the evidence has not been systematically reviewed to determine the effectiveness of patient education using avatar-based technology on patients' knowledge and self-care behaviors in chronic disease.

INCLUSION CRITERIA

This review included studies of children and adults who have received avatar-based patient education interventions. The comparator was usual care or other forms of educational programs. The outcomes were knowledge, self-care behavior, self-efficacy, health-related quality of life, readmission and medication adherence. Experimental designs were eligible, including non-randomized controlled trials, and quasi-experimental, prospective and retrospective before and after studies.

METHODS

Seven databases, including MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, ProQuest, Web of Science, Scopus and three other trial registries, including the World Health Organization (WHO), ClinicalTrials.gov and Australian New Zealand Clinical Trials Registry, were systematically searched for studies published between January 2005 and March 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management Assessment and Review of Information (JBI SUMARI). Data extracted from papers included specific details about the interventions, populations, study methods and outcomes significant to the review question and specific objectives using the standardized data extraction tool from JBI SUMARI. Due to heterogeneity among the included studies, statistical pooling and meta-analysis were not possible. The results were tabulated, and the data narratively synthesized.

RESULTS

Nine publications from eight studies were included in this review (n = 752). Three out of the eight studies were randomized controlled trials and five were non-randomized experimental studies. The overall quality of the included studies was moderate. There was a low risk of bias for the randomized controlled trial studies and moderate risk of bias for the quasi-experimental studies. Four of the eight studies showed that patients who participated in avatar-based education had a statistically significant improvement in knowledge (p < 0.05). Three studies showed improvement in behaviors and self-efficacy. Only three of eight studies examined health-related quality of life and adherence to medication, but the results were not statistically significant (p > 0.05). No studies identified the effectiveness of avatar-based patient education on readmission.

CONCLUSIONS

Avatar-based technology in patient education can have a positive effect on a wide range of healthcare outcomes. The intervention can improve knowledge, self-care behaviors and self-efficacy in patients with chronic diseases. However, there is limited evidence of improvement in health-related quality of life and adherence to medication, and no available research on readmission.

Exploration of Decisional Control Preferences in Adolescents and Young Adults with Cancer and Other Complex Medical Conditions

Purpose: Adolescent and young adults (AYA) with cancer encounter many medical treatment decisions but may have variable desires for involvement in decision-making. This study describes the degree of decisional control AYA patients preferred in complex medical decisions. Methods: A cross-sectional descriptive correlational design evaluated experienced AYA patients' decision-making role preferences using the Control Preference Scale and explored relationships in a proposed model of decision control. Results: Overall, most patients preferred an "active collaborative" role (39%), where the patient prefers to make the final decision with input from the provider, or a "shared decision-making" role (34%), wherein the decision is jointly made between patient and provider. Oncology AYA patients tended to prefer a more passive role than nononcology AYA patients. Time since diagnosis also positively correlated with control preference, with patients preferring a more active level of decisional control as the number of days from diagnosis increased. While no other statistically significant relationships were found between factors put forth in the exploratory model and decision control, there were strong associations between the factors themselves that warrant future study. Conclusion: The findings advance the knowledge of AYA preferences for decision-making involvement, enhancing our ability to identify patients at risk for low health care engagement and explore the consequences of limited or impaired decisional capacity. Future research might examine interventions to promote self-management skills and patient decisional role preferences, fulfilling the need to respect both the desire for decision-making involvement of some patients and the preference to defer to the expertise of providers for others.

Sharing the pain: an observational analysis of Twitter and pain in Ireland

INTRODUCTION

Studies involving Twitter and chronic pain can provide highly valuable patient-generated information. The aim of this paper was to examine pain-related tweets in Ireland over a 2-week period from 22 June 2017 to 5 July 2017 using pain-related keywords. We wished to identify Twitter user gender profile; most common discussion topics; sentiment analysis; and dissemination of tweets.

METHODS

A third-party data analytics company conducted a Twitter social media analysis over a randomly chosen 14-day period between the dates 22 June and 5 July 2017. All relevant keywords were included in the search. Author group consensus yielded 24 terms. Geographical location was restricted to Ireland. A computational sentiment dictionary was used to provide a rating of the emotional properties of the text on a 9-point scale from -5 to +4 of negative to positive sentiment. Dissemination was calculated by the number of times the tweet was displayed ('impressions').

RESULTS

There were 941 tweets identified during the study from 715 contributors. These generated 2.88 million impressions. The most frequently occurring keywords were headache (n=321); migraine (n=147); back pain (n=123); cannabis (n=114); and chronic pain (n=85). There were 1.94 times as many tweets from females as males. The highest proportion of tweets from female users was in the fibromyalgia (83%) and migraine (60%) categories; and from males in the sciatica (35%), chronic pain (34%) and back pain (32%) categories. Cannabis-related tweets reflected mostly non-personal content (90%), with a highly positive sentiment, and the highest number of impressions per tweet. The largest amount of advice was offered in the back pain category. Reposting of other users' content ('retweets') was more likely to contain a positive sentiment.

CONCLUSION

A substantial discussion of pain-related topics took place on Twitter during our study period. This provided real-time, dynamic information from individuals on discussion topics in pain medicine. This can be used to gain a greater understanding of the pain experience. As patients are increasingly acquiring healthcare information through online sources, high-quality information from approved sources should be promoted on such platforms.

Analysis of Answers to Queries among Anonymous Users with Gastroenterological Problems on an Internet Forum

Internet forums are an attractive source of health-related information. We aimed to investigate threads in the gastroenterological section of a popular Polish medical forum for anonymous users. We characterised the following aspects in threads: the main problem of the original poster, declared ailments and rationale of the responses (rational, neutral, harmful or not related to the problem of the original poster). We analysed over 2717 forum threads initiated in the years 2010–2018. Users mostly asked for diagnosis of the problem [1814 (66.8%)], treatment [1056 (38.9%)] and diagnostic interpretation [308 (11.3%)]. The most commonly declared symptoms were abdominal pain [1046 (38.5%)], diarrhea [454 (16.7%)] and bloating [354 (13.0%)]. Alarm symptoms were mentioned in 309 (11.4%) threads. From the total 3550 responses, 1257 (35.4%) were assessed as rational, 693 (19.5%) as neutral, 157 (4.4%) as harmful and 1440 (40.6%) as not related to the user’s problem. The original poster’s declaration of blood in stool, dyspepsia, pain in the abdominal right lower quadrant, weight loss or inflammatory bowel disease was positively related to obtaining at least one potentially harmful response. Advice from anonymous users on Internet forums may be irrational and disregards alarm symptoms, which can delay the diagnosis of life-threatening diseases.

Sense making in complex health situations

Purpose

Using a sense making approach, the purpose of this paper is to examine the role that virtual health communities play as a source of informational and social support for pregnant diabetic women. The paper helps to understand how women suffering from a critical medical condition (i.e. diabetes during pregnancy and birth) manage a complex health situation.

Design/methodology/approach

The data sample consisted of 507 posts collected from a virtual health community for diabetic pregnant women. Data were analysed deductively looking for different expressions of normality and different types of health information about diabetes.

Findings

Content analysis revealed four themes that reflect the process that diabetic women go through from their attempts to conceive through pregnancy and birth. The findings show that for women dealing with a chronic illness such as diabetes, the breakdown of normal was the beginning of the pregnancy that prompted a new range of informational and emotional needs. The members of the community negotiated a socially constructed sense of normality and tried to empower other members with a new sense of normal by sharing information about their births. The findings also showed that members of the community disclosed personal health information to elicit medical information, advice and social support from other members.

Originality/value

The study highlighted the significance of sense-making processes in managing complex health situations and the value of virtual communities as sources of information and social support as to resolve discontinuities in the management of their illnesses.

Differences in Perceptions of Health Information Between the Public and Health Care Professionals: Nonprobability Sampling Questionnaire Survey

Background

In the new media age, the public searches for information both online and offline. Many studies have examined how the public reads and understands this information but very few investigate how people assess the quality of journalistic articles as opposed to information generated by health professionals.

Objective

The aim of this study was to examine how public health care workers (HCWs) and the general public seek, read, and understand health information and to investigate the criteria by which they assess the quality of journalistic articles.

Methods

A Web-based nonprobability sampling questionnaire survey was distributed to Israeli HCWs and members of the public via 3 social media outlets: Facebook, WhatsApp, and Instagram. A total of 979 respondents participated in the online survey via the Qualtrics XM platform.

Results

The findings indicate that HCWs find academic articles more reliable than do members of the general public (44.4% and 28.4%, respectively, P<.001). Within each group, we found disparities between the places where people search for information and the sources they consider reliable. HCWs consider academic articles to be the most reliable, yet these are not their main information sources. In addition, HCWs often use social networks to search for information (18.2%, P<.001), despite considering them very unreliable (only 2.2% found them reliable, P<.001). The same paradoxes were found among the general public, where 37.5% (P<.001) seek information via social networks yet only 8.4% (P<.001) find them reliable. Out of 6 quality criteria, 4 were important both to HCWs and to the general public.

Conclusions

In the new media age where information is accessible to all, the quality of articles about health is of critical importance. It is important that the criteria examined in this research become the norm in health writing for all stakeholders who write about health, whether they are professional journalists or citizen journalists writing in the new media.

Perceptions of Food Hypersensitivity Expertise on Social Media: Qualitative Study

Background

Seeking and sharing information are the primary uses of the internet and social media. It is therefore vital to understand the processes individuals go through when engaging with information on these diverse platforms, especially in areas such as health- and risk-related information. One important element of such engagement is evaluating and attributing expertise to others.

Objective

This study aimed to explore how meanings around expertise in relation to food allergy and intolerance (food hypersensitivity) were constructed by 2 groups of social media users: (1) those who use platforms for reasons relating to food hypersensitivity and (2) those seen as experts by this community.

Methods

Survey participants were asked open-ended questions to identify potential experts in food hypersensitivity issues on social media and to discuss their reasoning for their choices (n=143). Subsequently, 8 adult social media users with experience of managing food hypersensitivity and 5 participants designated as experts by those users took part in email interviews. Survey and interview data were analyzed thematically using Braun and Clarke’s approach.

Results

Judging expertise on social media is a complex and multifaceted process. Users might be judged as experts through their professional background or their experience living with food hypersensitivities. How users behave on social media and the traces of their Web-based activity can influence how others will see them. Such considerations are both measured and moderated through the social media community itself. Findings highlighted how social media often act as a supportive information tool following a diagnosis, but this also raised concerns regarding the scenario of patients not being able to access suitable vetted information.

Conclusions

This work has implications for understanding how users perceive expertise on social media in relation to a health concern and how information assessments are made during the management of risks. Findings provide practical insights to both medical and organizational stakeholders involved in the support of those living with life-changing conditions, such as food hypersensitivities.

Maximizing New Technologies to Treat Depression

In an era of rapid technological evolution, mental healthcare providers are tapping into technology that offers feasible and effective alternatives to reach patients who suffer from depression. This paper provides a brief history and description of current technologies, frequently used taxonomies, and specific applications for the assessment and treatment of depression. These include online healthcare communities and social media, automated screening, wearable technology, and virtual reality therapy. A review of a secondary analysis that incorporated technology used with patients experiencing depressive symptoms is provided and future trends in mHealth or cellular-based technologies to treat depression are explored.

Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study

Background

Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance.

Objective

The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods

Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes’s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0.

Results

A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R²=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=−.095, 95% CI −0.227 to −0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI −0.42 to −0.01) and moderate levels (95% CI −0.27 to −0.01) of fatigue.

Conclusions

Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use.

Prevention of HIV and Other Sexually Transmissible Infections in Expatriates and Traveler Networks: Qualitative Study of Peer Interaction in an Online Forum

Background

In high-income countries such as Australia, an increasing proportion of HIV cases have been acquired overseas, including among expatriates and travelers. Australia’s national strategies have highlighted the need for public health interventions for priority populations. One approach is to expand efforts to places or spaces where expatriate communities reside. Online settings such as forums used by expatriates and travelers have potential for preventing sexually transmissible infections with those hard to reach through more traditional interventions.

Objective

Our objectives were to (1) identify and describe domains of social interaction and engagement in 1 online forum used by Australian expatriates and travelers living or working in Thailand; and (2) make recommendations to health-promoting organizations and policy makers regarding the role of these forums in public health interventions with mobile populations who may be at risk of acquiring HIV or other sexually transmissible infections.

Methods

We identified forums and users in 2 stages. We identified 13 online forums and analyzed them for inclusion criteria. We searched 1 forum that met the required criteria for users who met inclusion criteria (n=5). Discussion threads, rather than individual posts, were units of analysis. For each user, we collected as transcripts the first 100 posts and 10 most recent posts, including the thread in which they were posted. We analyzed and thematically coded each post (n=550). Transcripts and analyses were reviewed and refined by multiple members of the research team to improve rigor. Themes were not totally emergent but explored against symbolic interactionism concepts of presentation of self, meaning, and socialization.

Results

Key domains were as follows: the forum (characteristics of the space and reasons for use), gaining access (forum hierarchy and rules), identity (presentation of self and role of language), advice, support, and information (sources of information, support provided, influencers, topics of discussion, and receptiveness to advice), and risk (expectations and perceptions). The forum exhibited evidence of unique language, rules and norms, and processes for managing conflict and key influencers. The forum was a substantial source of health information and advice provided to users via confirmation, reassurance, or affirmation of beliefs and experiences. Risk perception and expectations varied. Risk taking, including around sex, appeared to be a key expectation of travel or the experience of being an expatriate or traveler.

Conclusions

Australian expatriate and long-term traveler participation in the online forum formed, influenced, and reinforced knowledge, attitudes, interaction, and identity. Such forums can be used by policy makers and health-promoting organizations to provide supplementary sources of support and information to hard-to-reach mobile populations who may be at risk of acquiring HIV or other sexually transmissible infections. This will complement existing engagement with health professionals and other public health interventions.

How New and Expecting Fathers Engage With an App-Based Online Forum: Qualitative Analysis

Background

Breastfeeding is important for infants, and fathers are influential in supporting their partner in their decision to breastfeed and how long they breastfeed for. Fathers can feel excluded from traditional antenatal education and support opportunities but highly value social support from peers. Online health forums can be a useful source of social support, yet little is known about how fathers would use a conversation forum embedded in a breastfeeding-focused app. Milk Man is a mobile app that aimed to increase paternal support for breastfeeding using a range of strategies, including a conversation forum.

Objective

The aim of this study was to examine how fathers used a breastfeeding-focused conversation forum contained within a mobile app throughout the perinatal period.

Methods

A qualitative analysis of comments posted by users in the online forum contained within the Milk Man app was conducted. The app contained a library of information for fathers, as well as a conversation forum. Thematic analysis was used to organize and understand the data. The NVivo 11 software package was used to code comments into common nodes, which were then organized into key themes.

Results

In all, 208 contributors (35.5% [208/586] of those who had access to the app) posted at least once within the forum. In total, 1497 comments were included for analysis. These comments were coded to 3799 individual nodes and then summarized to 54 tree nodes from which four themes emerged to describe how fathers used the app. Themes included seek and offer support, social connection, informational support provision, and sharing experiences. Posting in the forum was concentrated in the antenatal period and up to approximately 6 weeks postpartum.

Conclusions

These data show that fathers are prepared to use a breastfeeding-focused online forum in a variety of ways to facilitate social support. Fathers can be difficult to reach in the perinatal period, yet engaging them and increasing social support is important. This research demonstrates the acceptability of an innovative way of engaging new and expecting fathers.

Identifying tweets of personal health experience through word embedding and LSTM neural network

BACKGROUND

As Twitter has become an active data source for health surveillance research, it is important that efficient and effective methods are developed to identify tweets related to personal health experience. Conventional classification algorithms rely on features engineered by human domain experts, and engineering such features is a challenging task and requires much human intelligence. The resultant features may not be optimal for the classification problem, and can make it challenging for conventional classifiers to correctly predict personal experience tweets (PETs) due to the various ways to express and/or describe personal experience in tweets. In this study, we developed a method that combines word embedding and long short-term memory (LSTM) model without the need to engineer any specific features. Through word embedding, tweet texts were represented as dense vectors which in turn were fed to the LSTM neural network as sequences.

RESULTS

Statistical analyses of the results of 10-fold cross-validations of our method and conventional methods indicate that there exist significant differences (p < 0.01) in performance measures of accuracy, precision, recall, F1-score, and ROC/AUC, demonstrating that our approach outperforms the conventional methods in identifying PETs.

CONCLUSION

We presented an efficient and effective method of identifying health-related personal experience tweets by combining word embedding and an LSTM neural network. It is conceivable that our method can help accelerate and scale up analyzing textual data of social media for health surveillance purposes, because of no need for the laborious and costly process of engineering features.

Community water fluoridation online: an analysis of the digital media ecosystem

OBJECTIVES

Research demonstrates the safety and efficacy of community water fluoridation (CWF). Yet, the digitization of communication has triggered the spread of inaccurate information online. The purpose of this study was to analyze patterns of CWF information dissemination by a network of sources on the web.

METHODS

We used Media Cloud, a searchable big data platform of over 550 million stories from 50 thousand sources, along with tools to analyze that archive. We generated a network of fluoridation publishers using Media Cloud's keyword identification from August 1, 2015 to July 31, 2016. We defined the media type and sentiment toward CWF for each source and generated a network map of the most influential sources during our study period based on hyperlinking activity.

RESULTS

Media Cloud detected a total of 980 stories from 325 different sources related to water fluoridation. We identified nine different media types participating in the dissemination of information: academic, government, scientific group, natural medicine, blogs, mainstream media, advocacy groups, user-generated (e.g., YouTube), and "other." We detected five sub-networks within the overall fluoridation network map, each with its own characteristics. Twenty-one percent of sources were pro-fluoridation, receiving 57 percent of all inlinks, 22 percent of sources were anti-fluoridation, and the rest were neutral (54 percent).

CONCLUSIONS

The dominant neutral sentiment of the network may signify that anti- and pro-sides of the debate are viewed as balanced, not just in number but also in quality of information. Despite high inlinks to pro-sources, anti-fluoridation sentiment maintains influence online.

Understanding Trail Runners' Activity on Online Community Forums: An Inductive Analysis of Discussion Topics

Recreational trail runners often participate in online community forums where they can freely read posted messages, join discussions and/or introduce new discussion topics. This tool can enhance learning as runners connect with other trail runners and reflect on how they can better organize their own practice. Studying forum activity would provide greater insight into the relationship between field practice and dedicated forums. The aim of this study was therefore to detect the topics discussed online by trail runners in order to understand how they collectively look for solutions that help them adapt to issues that emerge during actual practice. The discussion topics (n = 171) on the forum hosted by the Raidlight brand were examined using inductive content analysis, which distinguished two general dimensions. The first dimension was training and had four first-order themes (i.e., “specific trail running sessions”, “complementary trail running sessions”. “training plans” and “specific questions about races”) grouped into two second-order themes (i.e., “training session contents” and “structure and schedule”). The second dimension was health and had seven first-order themes (i.e., “tendinitis”, “muscle issues”, “foot issues”, “sprains and fractures”, “pain”, “physiology” and “substances and practitioners”) grouped into two second-order themes (i.e., “pain and injury” and “prevention”). The results indicate that the issues that trail runners discuss on forums are significant and that the successions of questions and solutions are a fruitful means for building, enriching and adjusting their activity as they cope with constraints. As a practical consequence, suggestions for improving such online platforms are made.

The Use of Online Health Forums by Patients With Chronic Cough: Qualitative Study

Background

Online health discussion forums are used by different patient groups for sharing advice and information. Chronic cough is a common problem, and people with chronic cough use online health forums alongside formal medical therapies.

Objective

The objective of this study was to assess how chronic cough sufferers use online health forums, including the treatment advice they share with one another and the possible clinical uses of online forums in chronic cough.

Methods

Three open-access health forums were searched for threads related to chronic cough. Identified threads were screened against inclusion and exclusion criteria adapted from the British Thoracic Society (BTS) Guidelines related to chronic cough diagnosis. Included data were subjected to qualitative thematic analysis. All study data were cross-validated by a second author and discrepancies were resolved.

Results

In total, 96 threads were included in the analysis, consisting of posts by 223 forum users. Three main themes were identified: the effect of chronic cough on the lives of patients, the treatment advice shared between users, and the provision of support within forums.

Conclusions

Chronic cough symptoms had impacts on multiple aspects of patients’ health and well-being. To try and combat these issues, forum users suggested a variety of treatments to one another, ranging from mainstream traditional therapies to odd alternative remedies. The provision of support and empathy were also prominent themes in discussion threads. Online forums themselves may provide increasing benefit to users through the addition of a moderator.

Alemtuzumab in Multiple Sclerosis: Lessons from Social Media in Enhancing Patient Care

BACKGROUND

Alemtuzumab is a monoclonal antibody that has been approved for the treatment of relapsing-remitting multiple sclerosis (MS). Alemtuzumab is associated with infusion reactions and potential autoimmune complications. Patient education and understanding are crucial to favorable outcomes. Our objective was to observe communication on a peer-to-peer Facebook group for content, accuracy of posts, and number of "likes" per post and to compare shared themes to current approved prescribing information and educational modules.

METHODS

We identified a Facebook group specific to alemtuzumab in MS. A 14-day window was observed. Posts were classified as "sharing" or "seeking information." Content analysis was used for information-seeking posts. Accuracy of replies was compared with product prescribing information.

RESULTS

We reviewed 458 posts. Members contemplating receiving or currently receiving alemtuzumab primarily used Facebook for information gathering (54.6%), followed by seeking emotional support and sharing personal experiences (45.4%). Most shared experiences (83.6%) were positive. Themes for information were predominantly consistent with standard protocols. Complications discussed included infection (15.50%), bone pain (11.80%), immune thrombocytopenia (8.07%), and fatigue (7.46%). Accuracy of replies was consistent with product information except for immune thrombocytopenia.

CONCLUSIONS

Some patients with MS look to online groups for discussion, peer support, and information. Although written guidelines on the studied home page reinforce that online discussion "does not replace medical advice," inaccurate information does occur. Health-care providers' reviews of these online sites allow insight into the real-world experiences of patients receiving alemtuzumab, with potential for modification of educational approaches by health-care professionals.

Mining social media data: How are research sponsors and researchers addressing the ethical challenges?

Background:

Data representing people’s behaviour, attitudes, feelings and relationships are increasingly being harvested from social media platforms and re-used for research purposes. This can be ethically problematic, even where such data exist in the public domain. We set out to explore how the academic community is addressing these challenges by analysing a national corpus of research ethics guidelines and published studies in one interdisciplinary research area.

Methods:

Ethics guidelines published by Research Councils UK (RCUK), its seven-member councils and guidelines cited within these were reviewed. Guidelines referring to social media were classified according to published typologies of social media research uses and ethical considerations for social media mining. Using health research as an exemplar, PubMed was searched to identify studies using social media data, which were assessed according to their coverage of ethical considerations and guidelines.

Results:

Of the 13 guidelines published or recommended by RCUK, only those from the Economic and Social Research Council, the British Psychological Society, the International Association of Internet Researchers and the National Institute for Health Research explicitly mentioned the use of social media. Regarding data re-use, all four mentioned privacy issues but varied with respect to other ethical considerations. The PubMed search revealed 156 health-related studies involving social media data, only 50 of which mentioned ethical concepts, in most cases simply stating that they had obtained ethical approval or that no consent was required. Of the nine studies originating from UK institutions, only two referred to RCUK ethics guidelines or guidelines cited within these.

Conclusions:

Our findings point to a deficit in ethical guidance for research involving data extracted from social media. Given the growth of studies using these new forms of data, there is a pressing need to raise awareness of their ethical challenges and provide actionable recommendations for ethical research practice.

Ill Literates or Illiterates? Investigating the eHealth Literacy of Users of Online Health Communities

Background

Electronic health (eHealth) literacy is an important skill that allows patients to navigate intelligibly through the vast, often misleading Web-based world. Although eHealth literacy has been investigated in general and specific demographic populations, it has not yet been analyzed on users of online health communities (OHCs). Evidence shows that OHCs are important Web 2.0 applications for patients for managing their health, but at the same time, warnings have been expressed regarding the quality and relevance of shared information. No studies exist that investigate levels of eHealth literacy among users of OHCs and differences in eHealth literacy between different types of users.

Objective

The study aimed to investigate eHealth literacy across different types of users of OHCs based on a revised and extended eHealth literacy scale (eHEALS).

Methods

The study was based on a cross-sectional Web survey on a simple random sample of 15,000 registered users of the most popular general OHC in Slovenia. The final sample comprised 644 users of the studied OHC. An extended eHEALS (eHEALS-E) was tested with factor analytical procedures, whereas user types were identified with a hierarchical clustering algorithm. The research question was analyzed with analysis of variance (ANOVA) procedure and pairwise comparison tests.

Results

Factor analysis of the revised and extended eHEALS revealed six dimensions: awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information, and being smart on the Net. The factor solution demonstrates a good fit to the data (root mean square error of approximation [RMSEA]=.059). The most developed dimension of eHEALS-E is awareness of different Internet sources (mean=3.98, standard deviation [SD]=0.61), whereas the least developed is understanding information (mean=3.11, SD=0.75). Clustering resulted in four user types: active help-seekers (48.3%, 311/644), lurkers (31.8%, 205/644), core relational users (16.9%, 109/644), and low-engaged users (3%, 19/644). Analysis of the research question showed statistically significant differences among user types across all six dimensions of eHEALS-E. Most notably, core relational users performed worse than lurkers on the validating information dimension (P=.01) and worse than active help-seekers on the being smart on the Net dimension (P=.05). Active help-seekers have the highest scores in all dimensions of the eHEALS-E, whereas low-engaged users have statistically significantly lower scores on all dimensions of the eHEALS-E in comparison with the other groups.

Conclusions

Those who are looking for advice and support in OHCs by making queries are well equipped with eHealth literacy skills to filter potential misinformation and detect bad advice. However, core relational users (who produce the most content in OHCs) have less-developed skills for cross-validating the information obtained and navigating successfully through the perils of the online world. Site managers should monitor their activity to avoid the spread of misinformation that might lead to unhealthy practices.

A Thematic Analysis of Online Discussion Boards for Vasectomy

OBJECTIVE

To examine posts on Internet discussion groups related to vasectomies, and identify common ideas through a structured theme analysis.

MATERIALS AND METHODS

Internet discussion boards were identified using the search term "vasectomy." Three discussion boards were identified as having the most posts and were chosen for analysis. Using an iterative and structured analysis process, each post was analyzed using thematic analysis in 3 steps (open coding, axial coding, and selective coding) to determine common themes.

RESULTS

A total of 129 posts were analyzed. The most common posts related to changes in sexual function after vasectomy. The second most common theme was pain after vasectomy. There were also posts about considerations before vasectomy, planning for postvasectomy care, what to expect after vasectomy, potential issues after vasectomy and how to manage these, and feelings about vasectomy. Some of the information present did not have a factual basis.

CONCLUSION

Posts dedicated to postvasectomy pain and sexual dysfunction were of the highest quantity. There was no medical provider input to these discussion boards. Educational efforts should be targeted to these areas and should include a health-care professional.

Beyond Words: Amplification of Cancer Risk Communication on Social Media

Social media provide a unique channel for disseminating evidence-based information to diverse audiences and organizational and private stakeholders, thus facilitating a dialog about health and health risks. Guided by the social amplification of risk framework, the goal of this study was to assess the level of audience engagement with messages posted on the National Cancer Institute (NCI) Facebook page and evaluate the differences in the audience information behavior toward risk-related and non-risk posts. Data included 1,975 posts published on the NCI Facebook page as well as the corresponding 4,537 comments, 77,298 shares, and 145,462 likes. Links and images were the top two most frequent types of content for both risk-related and non-risk posts, but risk-related messages were more amplified through comments, shares, and likes. Comparing the modality of risk-related messages, videos, contrary to the prediction, were not more effective in attracting audience engagement than images. Finally, comments to risk-related posts did not repeat risk-related language suggesting that future studies should examine risk signal recognition and dissemination as separate behaviors. This study's findings emphasize the importance of focused investigation of message design strategies and message effects on the dissemination and amplification of communication related to health risks.

Health-Related Coping and Social Interaction in People with Multiple Sclerosis Supported by a Social Network: Pilot Study With a New Methodological Approach

BACKGROUND

Social media are a vital link for people with health concerns who find in Web communities a valid and comforting source for information exchange, debate, and knowledge enrichment. This aspect is important for people affected by chronic diseases like multiple sclerosis (MS), who are very well informed about the disease but are vulnerable to hopes of being cured or saved by therapies whose efficacy is not always scientifically proven. To improve health-related coping and social interaction for people with MS, we created an MS social network (SMsocialnetwork.com) with a medical team constantly online to intervene promptly when false or inappropriate medical information are shared.

OBJECTIVE

The goal of this study was to assess the impact of SMsocialnetwork.com on the health-related coping and social interaction of people with MS by analyzing areas of interest through a Web-based survey.

METHODS

Referring to previous marketing studies analyzing the online platform's role in targeted health care, we conducted a 39-item Web-based survey. We then performed a construct validation procedure using a factorial analysis, gathering together like items of the survey related to different areas of interest such as utility, proximity, sharing, interaction, solving uncertainty, suggestion attitude, and exploration.

RESULTS

We collected 130 Web-based surveys. The areas of interest analysis demonstrated that the users positively evaluated SMsocialnetwork.com to obtain information, approach and solve problems, and to make decisions (utility: median 4.2); improve feeling of closeness (proximity: median 5); catalyze relationships and text general personal opinions (sharing: median 5.6); get in touch with other users to receive innovative, effective, and practical solutions (interaction, solving uncertainty, and suggestion attitude medians were respectively: 4.1, 3, and 3); and share information about innovative therapeutic approaches and treatment options (suggestion attitude: median: 3.3).

CONCLUSIONS

SMsocialnetwork.com was perceived by users to be a useful tool to support health-related coping and social interaction, and may suggest a new kind of therapeutic alliance between physicians and people with MS.

The "New Public" and the "Good Ol' Press": Evaluating Online News Sources During the 2013 Polio Outbreak in Israel

The current research focuses on the 2013 polio outbreak in Israel as a case study to analyze the sources of information used in new media platforms, examining whether the new media have changed the ways in which we communicate about health issues. Specifically, we tracked and coded polio-related references on Hebrew news websites, blogs, forums, and Facebook posts. Overall, 24,388 polio-related references constituted our sampling frame. The findings suggest that there is a moderate-level correlation between the platform and the type of sources chosen by users. Beyond the differences between various platforms, we found that online information platforms rely not only on popular or pseudoscientific sources, but also on high-quality information. In fact, the analysis indicates that online news websites, forums, blogs, and Facebook posts create a unique blend of information, including scientific literature, medical professionals, and government representatives, as well as pseudoscientific research. These findings suggest a more optimistic view of the Internet as a source for health-related information in times of crises. Although the fact that members of the public are exposed to scientific sources does not indicate to what degree this affects their actual decision making. Exposure to a wider variety of sources may enhance health literacy, resulting in a better understanding of information needed to make informed decisions.

Like or Dislike? Impact of Facebook on Ewing Sarcoma Treatment

Background

An increasing number of patients are raising their voices in online forums to exchange health-related information. Facebook is the leading social media platform with more than 1 billion international daily users recorded in the summer of 2015. Facebook has a dynamic audience and is utilized in a number of ways, discussing medical issues being one of them. Ewing sarcoma mainly affects teenagers and young adults. Additionally, many individuals within this age group are regular users of Facebook. However, little is known about the impact of this modern way of communication via Web-based platforms on patients with Ewing sarcoma and their social environment.

Objective

The aim of this study was to analyze and compare Ewing sarcoma patients’ and relatives’ behavior on Facebook to draw conclusions regarding the impact of Facebook on Ewing sarcoma treatment.

Methods

We examined a Facebook group named “Ewing Sarcoma Awareness” that is used to exchange information for both patients and relatives regarding Ewing sarcoma. A self-designed questionnaire was used to compare patients’ and relatives’ answers. Additionally, we analyzed all processes (posts, likes, threads, links) in the group for 6 consecutive months. A total of 65 members of the Facebook group (26 patients, 39 relatives) out of 2227 international group members participated in our study.

Results

More than 70% (46/65) of all participants reported that they use the group Ewing Sarcoma Awareness as a source of information about Ewing sarcoma. Of the participants, 89% (58/65) agreed on our scale from a little to a lot that being in contact with other affected people through the group makes it easier to handle the diagnosis. In this study, 20% (13/65) of all participants reported that the group affected their choice of treatment and 15% (10/65) of participants were influenced in the selection of their specialist. Regarding the recommendation of the Facebook group toward other people, significant differences (P=.003) were found comparing patients’ and relatives’ results. During the last 6 months most activities in the group concerned sharing destiny and handling the diagnosis.

Conclusions

The Facebook group Ewing Sarcoma Awareness has a relevant impact on group members regarding their choice of treatment. Moreover, participants turn toward the group to receive mental and emotional support in everyday life. Statements made within the group are in part questionable from a medical point of view and the impact made by these statements on patients’ care requires further evaluation.

From Help-Seekers to Influential Users: A Systematic Review of Participation Styles in Online Health Communities

BACKGROUND

Understanding how people participate in and contribute to online health communities (OHCs) is useful knowledge in multiple domains. It is helpful for community managers in developing strategies for building community, for organizations in disseminating information about health interventions, and for researchers in understanding the social dynamics of peer support.

OBJECTIVE

We sought to determine if any patterns were apparent in the nature of user participation across online health communities.

METHODS

The current study involved a systematic review of all studies that have investigated the nature of participation in an online health community and have provided a quantifiable method for categorizing a person based on their participation style. A systematic search yielded 20 papers.

RESULTS

Participatory styles were classified as either multidimensional (based on multiple metrics) or unidimensional (based on one metric). With respect to the multidimensional category, a total of 41 different participation styles were identified ranging from Influential Users who were leaders on the board to Topic-Focused Responders who focused on a specific topic and tended to respond to rather than initiate posts. However, there was little overlap in participation styles identified both across OHCs for different health conditions and within OHCs for specific health conditions. Five of the 41 styles emerged in more than one study (Hubs, Authorities, Facilitators, Prime Givers, and Discussants), but the remainder were reported in only one study. The focus of the unidimensional studies was on level of engagement and particularly on high-engaged users. Eight different metrics were used to evaluate level of engagement with the greatest focus on frequency of posts.

CONCLUSIONS

With the exception of high-engaged users based on high post frequency, the current review found little evidence for consistent participatory styles across different health communities. However, this area of research is in its infancy, with most of the studies included in the review being published in the last 2 years. Nevertheless, the review delivers a nomenclature for OHC participation styles and metrics and discusses important methodological issues that will provide a basis for future comparative research in the area. Further studies are required to systematically investigate a range of participatory styles, to investigate their association with different types of online health communities and to determine the contribution of different participatory styles within and across online health communities.

Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum

Background

The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions.

Objective

We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience.

Methods

By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion.

Results

There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the “downfall of the professional knowledge providers” and (2) the “rise of the nonprofessional treasure trove of experience.” The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions “trust in evidence-based knowledge,” “trust in experience-based knowledge,” and “subjectivity” (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement).

Conclusions

By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information.

When advocacy obscures accuracy online: digital pandemics of public health misinformation through an antifluoride case study

OBJECTIVES

In an antifluoridation case study, we explored digital pandemics and the social spread of scientifically inaccurate health information across the Web, and we considered the potential health effects.

METHODS

Using the social networking site Facebook and the open source applications Netvizz and Gephi, we analyzed the connectedness of antifluoride networks as a measure of social influence, the social diffusion of information based on conversations about a sample scientific publication as a measure of spread, and the engagement and sentiment about the publication as a measure of attitudes and behaviors.

RESULTS

Our study sample was significantly more connected than was the social networking site overall (P<.001). Social diffusion was evident; users were forced to navigate multiple pages or never reached the sample publication being discussed 60% and 12% of the time, respectively. Users had a 1 in 2 chance of encountering negative and nonempirical content about fluoride unrelated to the sample publication.

CONCLUSIONS

Network sociology may be as influential as the information content and scientific validity of a particular health topic discussed using social media. Public health must employ social strategies for improved communication management.

Personal experiences and emotionality in health-related knowledge exchange in Internet forums: a randomized controlled field experiment comparing responses to facts vs personal experiences

BACKGROUND

On the Internet, people share personal experiences as well as facts and objective information. This also holds true for the exchange of health-related information in a variety of Internet forums. In online discussions about health topics, both fact-oriented and strongly personal contributions occur on a regular basis.

OBJECTIVE

In this field experiment, we examined in what way the particular type of contribution (ie, factual information vs personal experiences) has an impact on the subsequent communication in health-related Internet forums.

METHODS

For this purpose, we posted parallelized queries to 28 comparable Internet forums; queries were identical with regard to the information contained but included either fact-oriented descriptions or personal experiences related to measles vaccination. In the factual information condition, we posted queries to the forums that contained the neutral summary of a scientific article. In the personal experiences condition, we posted queries to the forums that contained the same information as in the first condition, but were framed as personal experiences

RESULTS

We found no evidence that personal experiences evoked more responses (mean 3.79, SD 3.91) from other members of the Internet forums than fact-oriented contributions (mean 2.14, SD 2.93, t26=0.126, P=.219). But personal experiences elicited emotional replies (mean 3.17, SD 1.29) from other users to a greater extent than fact-oriented contributions (mean 2.13, SD 1.29, t81=3.659, P<.001).

CONCLUSIONS

We suggest that personal experiences elicited more emotional replies due to the process of emotional anchoring of people's own style of communication. We recommend future studies should aim at testing the hypotheses with more general and with less emotionally charged topics, constructing different fact-oriented posts, and examining additional potential factors of influence such as personality factors or particular communication situations.

Development of an interactive social media tool for parents with concerns about vaccines

OBJECTIVE

Describe a process for designing, building, and evaluating a theory-driven social media intervention tool to help reduce parental concerns about vaccination.

METHOD

We developed an interactive web-based tool using quantitative and qualitative methods (e.g., survey, focus groups, individual interviews, and usability testing).

RESULTS

Survey results suggested that social media may represent an effective intervention tool to help parents make informed decisions about vaccination for their children. Focus groups and interviews revealed four main themes for development of the tool: Parents wanted information describing both benefits and risks of vaccination, transparency of sources of information, moderation of the tool by an expert, and ethnic and racial diversity in the visual display of people. Usability testing showed that parents were satisfied with the usability of the tool but had difficulty with performing some of the informational searches. Based on focus groups, interviews, and usability evaluations, we made additional revisions to the tool's content, design, functionality, and overall look and feel.

CONCLUSION

Engaging parents at all stages of development is critical when designing a tool to address concerns about childhood vaccines. Although this can be both resource- and time-intensive, the redesigned tool is more likely to be accepted and used by parents. Next steps involve a formal evaluation through a randomized trial.

Tweeting for and against public health policy: response to the Chicago Department of Public Health's electronic cigarette Twitter campaign

BACKGROUND

In January 2014, the Chicago City Council scheduled a vote on local regulation of electronic cigarettes as tobacco products. One week prior to the vote, the Chicago Department of Public Health (CDPH) released a series of messages about electronic cigarettes (e-cigarettes) through its Twitter account. Shortly after the messages, or tweets, were released, the department's Twitter account became the target of a "Twitter bomb" by Twitter users sending more than 600 tweets in one week against the proposed regulation.

OBJECTIVE

The purpose of our study was to examine the messages and tweet patterns in the social media response to the CDPH e-cigarette campaign.

METHODS

We collected all tweets mentioning the CDPH in the week between the e-cigarette campaign and the vote on the new local e-cigarette policy. We conducted a content analysis of the tweets, used descriptive statistics to examine characteristics of involved Twitter users, and used network visualization and descriptive statistics to identify Twitter users prominent in the conversation.

RESULTS

Of the 683 tweets mentioning CDPH during the week, 609 (89.2%) were anti-policy. More than half of anti-policy tweets were about use of electronic cigarettes for cessation as a healthier alternative to combustible cigarettes (358/609, 58.8%). Just over one-third of anti-policy tweets asserted that the health department was lying or disseminating propaganda (224/609, 36.8%). Approximately 14% (96/683, 14.1%) of the tweets used an account or included elements consistent with "astroturfing"-a strategy employed to promote a false sense of consensus around an idea. Few Twitter users were from the Chicago area; Twitter users from Chicago were significantly more likely than expected to tweet in support of the policy.

CONCLUSIONS

Our findings may assist public health organizations to anticipate, recognize, and respond to coordinated social media campaigns.